Any effort to sell an overhaul of health care to a wary public must first clear some major hurdles with people who like the insurance they have and don’t see the need for change.

Those opposed to reform ask why anyone should risk having government come between patients and doctors, or why a system that works for millions of Americans needs reform.

But reform advocates say that without major changes, insurance costs will spiral out of control. Their argument in short: Your insurance plan is changing regardless of whether Congress takes action.

Take for example Elward Construction, a small Lakewood company struggling with a 40 percent jump in health care premiums for its employees in the past three years. The company is spending $684,000 a year to subsidize coverage for 100 employees and their families. That probably can’t be sustained forever.

Or consider the story of Boulder resident Kathryn Alexander, who was rejected repeatedly by insurance companies because of her pre-existing hip trouble. Then, struck by cancer, she filed for bankruptcy after racking up about $100,000 in medical bills — debt eventually passed on to people buying insurance.

Covering every person

Central to health-reform proposals — though clear legislation and a finance plan have yet to emerge — is that everyone, except perhaps illegal immigrants, will have insurance. Insurance companies will no longer get to turn away older, sick people, and to even things out, healthy 20-somethings will have to pay into the insurance system.

“You pay in because you don’t know what is going to happen to you tomorrow,” said Elisabeth Arenales, health care program director for the Colorado Center on Law and Policy. “The more people who are left out, the more difficult it is for the people who pay in. If we don’t do anything, costs are going to get higher and higher.”

The debate is confusing and emotional, but most everyone agrees that if all Americans had insurance, hospitals wouldn’t have to raise rates to compensate for the patients who don’t pay their bills, causing insurance companies to raise premiums and passing on the burden to customers.

Denver Health Medical Center chief executive Patricia Gabow was in Washington last month telling members of Congress the hospital is projected to spend $360 million this year caring for people with no insurance. That’s up from $275 million in 2007.

“The number of uninsured at our door and the cost for their care increases every year,” she said.

An estimated 47 million Americans, including 800,000 Coloradans, have no insurance. The percentage of Coloradans who are uninsured — 17 percent — is slightly worse than the national average of about 14.5 percent.

People without insurance are more likely to end up in the emergency room, sicker than they would have been had they gotten care sooner from a primary care doctor, said Joan Henneberry, executive director of the Colorado Department of Health Care Policy and Financing. Varying studies estimate 3 percent to 9 percent of insurance premiums are funding care for the uninsured — more than $1,000 a year for some.

“You have to get more people into the system and, at the same time, you have to try and manage their costs more aggressively,” Henneberry said. “Not having them in the system doesn’t save you money.”

No action: outlook poor

Without reform, economic projections are harsh.

A recent study by reform advocacy group Families USA predicted that 780 Coloradans per week would lose their health insurance coverage without reform, totaling more than 120,000 people from 2008 to 2010.

The escalating cost of premiums is resulting in fewer small businesses offering health benefits, according to the Denver-based Business Health Forum.

Colorado businesses dealt with a nearly 60 percent increase in their health premiums from 2000 to 2005, according to the group.

During the same period, employees’ contributions to family premiums grew an average of 85 percent, from $1,536 to $2,845. Wages, though, increased just 12 percent — a sign that employers are stifling salary increases because they have to put more money into health care.

How we’d pay doctors

Another key push in national reform would turn the reimbursement system upside down — doctors would get paid for providing preventive medicine and keeping patients healthy, not by the number of blood tests, scans and surgeries they do.

Many argue the national health system should look more like a Denver Health or Kaiser Permanente — integrated systems where patient data is linked through electronic medical records to primary care doctors, specialists and pharmacists. The set-up cuts down on duplicate paperwork and tests.

Kaiser has used electronic medical records for a dozen years. Patients can log into their health information similar to online banking, finding out test results or when they are due for a yearly check-up.

President Barack Obama’s stimulus package included $19 billion to convert millions of metal filing cabinets across the country to electronic records.

Kaiser also has attracted national attention for the way it pays doctors — they are salaried, so there is no incentive to do unnecessary tests. And they get bonuses for having good customer satisfaction and healthy patients.

The company is efficient too, said Donna Lynne, president of Kaiser Permanente Colorado. Kaiser premiums are generally 7 percent lower than competitors’ health plans in Colorado.

Kaiser wants a national health plan that would retain employer-subsidized insurance plans but add a public option for people who don’t get insurance through work and can’t afford it on their own. National proposals call for government subsidies to help people who might not qualify for Medicaid or Medicare but can’t afford private insurance.

“What we should do is address people who don’t have insurance,” Lynne said. “At the end of the day, my health care premium is higher than it should be because I’m still paying for those people who don’t have insurance.”

Over time, insurance companies say, premiums would drop if everyone paid into the system.

“If we were able to have a health care reform program that is holistic in nature and not just tweaking around the edges, we should see premiums abate,” said Beth Soberg, president of UnitedHealthcare of Colorado.

Change, but not for me

Still, major reforms that would cost taxpayers now and promise a payoff later are tough to sell — especially to people satisfied with what they’ve got, experts said.

An often-quoted survey among health-reform advocates says that about 80 percent of Americans think the health care system is broken. But when asked whether they want to change their own plan, an overwhelming majority say no.

“From a political standpoint, health care seems to be something that brings out more emotions in people,” said Mac Clouse, a finance professor at the University of Denver Daniels College of Business. “It’s not clear that anybody has really seen the plan in an easy-to-read and understandable format.”

Despite Obama’s sense of urgency, many say it’s unlikely any plan will emerge during the next several months.

“It’s so complex right now that people can’t get their arms around it,” said Bob McGowan, a DU professor of management. “It’s like trying to wrestle an 800-pound gorilla. Once you get a hold of it, it’s awful tough to manage.”

Other Coloradans, though, say delaying reform only increases its politicization. Besides, reform advocates say, the country has been talking about health care for years.

If the economic argument doesn’t work, there is always the compassionate one.

“Health reform is about who we are as a country,” said Arenales, of the Colorado Center on Law and Policy. “Do we want to continue to let people die because they don’t have health insurance, or do we have the will to change course?”

Jennifer Brown is an investigative reporter for The Denver Post, where she has worked since 2005. She has written about the child welfare system, mental health, education and politics. She previously worked for The Associated Press, The Tyler Morning Telegraph in Texas, and the Hungry Horse News in Montana.

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